1st night at Emergency

It was just another evening when Dhananjay sir came to my room last evening quite tired from his surgery posting and said that he was quite upset for the plans for the night. I was a bit surprised and asked him what was troubling him. Yesterday’s Wednesday and today is a local holiday. He replied that he was asked to do night duty at the emergency since there were fewer faculties there that night. It was quite depressing news for him. Since the surgery postings are pathetic and on top of that if it’s a night duty at emergency.

Central Referral Hospital, Gangtok

So we started chatting as always about our day and then what’s going on around the world. Then suddenly something struck my mind and I asked him whether I could join him on his night duty as the next day was our holiday. I didn’t expect that but he accepted my proposal wholeheartedly and even promised me to teach things also. I got excited and happy. There was still time for the duty. We had to report after 9 at night.

We went to have dinner and after it we headed towards the emergency. As we reached there; the faculties present there were quite amazed to see me there for being a 3rd semester student it’s quite uncommon to be at emergency night duty or any duty. As they asked me, Dhananjay sir informed them that I was with him so that I can learn some of the clinics. They asked me my name and particulars.

My first live cases

Babita madam, a Junior Resident, asked me to take BP of a patient who was already in emergency. I took the sphygmomanometer and was about to leave then she asked about the stethoscope. I showed her my pocket and she said that I am a medico and I should be wearing it on my neck as if it’s my jewelry.

Then I went for the patient. As she was my 1st real life patient I was quite tensed. Anyhow I took her BP and reported to ma’am. She asked me what the problem was. I said it’s my first time real life experience with a patient and it’s not lab subject. Then we spoke for some time as she relieved my nervousness. She explained that it happens when with every new students. I was feeling quite better then.

Dhananjay sir came and called me as we have to catheterize a patient. I was quite happy as he said that I would do it and he would just guide me. We went to the patient. He was quite old and a regular patient of catheterization. He was a patient of chronic kidney disease for a long time. He was admitted that night with problem of not being able to pass urine since catheter was removed in the morning. He had been on catheter for a long period but still no relief. Dhananjay sir was guiding me throughout the process as I catheterized the patient.

After some time another patient came to emergency. He was completely drunk and had no idea what had happened to him except the pain. He was brought there by his employers. They said he came running from uphill with bleeding and was shouting for his master. It was a medico-legal case. So we took him into the minor Operation Theater in the emergency. There we saw his wound. He got a cut with khukri, a type of knife used by Gurkhas and Nepalis. The cut was so worse that even his bone got fractured. Then we put a tile to immobilize the hand and further treatment was to be done by the Orthopaedic department after getting an X-ray done. Then we shifted him to general ward. After this case we sat for some time. My seniors were discussing about the infrastructure of the hospital.

First Neuro surgery case

After some time a patient was brought who fell backwards and got a head injury and was semi-conscious. He was having tremendous pain. Earlier today a neurosurgeon had joined our college. So he was called urgently to the emergency. The patient was taken for CT scan. After the radiography, we came to know that he had a lot of internal bleeding and clot on the right side of the brain. He also had his mid-line deviated and hemorrhoids on the left side. When we checked his pupils, we found that his right pupil was dilated very much and the left one was normal.

The neurosurgeon said the patient needs to be operated soon. The doctors convinced the patient party and took their consent. It was to be the 1st neurosurgery in Sikkim since there were no neurosurgeons in Sikkim before him. All such cases were referred to Siliguri before. I was excited to be able to witness the first neurosurgery. I was feeling to be a part of history!

The surgeon asked for shaving the head of the patient and place him on catheter. So Dhananjay sir and I started for shaving his head. We could not find the required instruments, so we did it with the scalpel and thread cutting scissors, to save time also. Time is very precious at this moment. With the help of the sisters there we shaved his head and then put the catheter. The patient was too restless due to the pain. Then he was taken to the Operation Theater [OT]. The instruments required for the operations were not complete there and our surgeon was disturbed because of that. Then he instructed for the instruments to be arranged asap. The Medical Officer called the Army hospital for the required equipments. He said that they would arrange and provide in 45 minutes. We stated the process for life support of the patient like ventilation and other things. Then surgeon sir started telling us about the situation of the patient. In fact, he was then taking our class right there in the OT. That time there were three assistants – one surgery PG student, one junior resident, one surgery assistant professor, one intern, one anesthetist and one 3rd semester student, that is me, in that single room. And the surgeon started to give us lecture on this type of cases.

The instruments arrived a bit late than expected. Then he started the operation and showed the ways of opening the skull and incisions on the scalp. As he started operation he came to know that all the equipment he got was really of poor quality and unused from a long time. Thus he started getting angry and scolded everybody there.

Another patient arrives

After some time there was a call from the emergency for help since there was another patient. So Nitin sir, PG student from surgery and I went down to see the case. There was this patient with lots of stab injuries over the chest and face. The patient was brought by the police and reported that he was stabbed by his own brother by a broken beer bottle, from which they two were drinking before the fight started. Then we took his X-ray and made him sleep some how. There was nothing serious about him. He had deep injuries but not deep enough to pierce the pleura. Then Dhananjay sir came down from the OT and said that the operation was successful and we returned back to the hostel at 7am in the morning.

This was my first night experience at the emergency of hospital. It was thrilling for me as I could encounter some live cases there and learned a lot.